Basic Information
| Provider Information | |||||||||
| NPI: | 1124065818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047787402 | ||||||||
| FaxNumber: | 4047784819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047125512 | ||||||||
| FaxNumber: | 4047784819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TR0400X | PSY0002953 | GA | Y | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No ID Information.